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Bruce C, Harrison P, Giammattei C, Desai SN, Sol JR, Jones S, Schwartz R. Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes. JMIR Mhealth Uhealth 2020; 8:e17577. [PMID: 33174846 PMCID: PMC7688390 DOI: 10.2196/17577] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/11/2020] [Accepted: 10/23/2020] [Indexed: 01/20/2023] Open
Abstract
Several recently published studies and consensus statements have demonstrated that there is only modest (and in many cases, low-quality) evidence that mobile health (mHealth) can improve patient clinical outcomes such as the length of stay or reduction of readmissions. There is also uncertainty as to whether mHealth can improve patient-centered outcomes such as patient engagement or patient satisfaction. One principal challenge behind the “effectiveness” research in this field is a lack of common understanding about what it means to be effective in the digital space (ie, what should constitute a relevant outcome and how best to measure it). In this viewpoint, we call for interdisciplinary, conceptual clarity on the definitions, methodologies, and patient-centered outcomes frequently used in mHealth research. To formulate our recommendations, we used a snowballing approach to identify relevant definitions, outcomes, and methodologies related to mHealth. To begin, we drew heavily upon previously published detailed frameworks that enumerate definitions and measurements of engagement. We built upon these frameworks by extracting other relevant measures of patient-centered care, such as patient satisfaction, patient experience, and patient activation. We describe several definitional inconsistencies for key constructs in the mHealth literature. In an effort to achieve clarity, we tease apart several patient-centered care outcomes, and outline methodologies appropriate to measure each of these patient-care outcomes. By creating a common pathway linking definitions with outcomes and methodologies, we provide a possible interdisciplinary approach to evaluating mHealth technologies. With the broader goal of creating an interdisciplinary approach, we also provide several recommendations that we believe can advance mHealth research and implementation.
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Affiliation(s)
- Courtenay Bruce
- System Quality & Patient Safety, Houston Methodist System, Houston, TX, United States
| | - Patricia Harrison
- System Quality & Patient Safety, Houston Methodist System, Houston, TX, United States
| | | | - Shetal-Nicholas Desai
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States.,Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Joshua R Sol
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States.,Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen Jones
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States.,Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Roberta Schwartz
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
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Bruce CR, Harrison P, Nisar T, Giammattei C, Tan NM, Bliven C, Shallcross J, Khleif A, Tran N, Kelkar S, Tobias N, Chavez AE, Rivera D, Leong A, Romano A, Desai SN, Sol JR, Gutierrez K, Rappel C, Haas E, Zheng F, Park KJ, Jones S, Barach P, Schwartz R. Assessing the Impact of Patient-Facing Mobile Health Technology on Patient Outcomes: Retrospective Observational Cohort Study. JMIR Mhealth Uhealth 2020; 8:e19333. [PMID: 32589161 PMCID: PMC7381069 DOI: 10.2196/19333] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite the growth of and media hype about mobile health (mHealth), there is a paucity of literature supporting the effectiveness of widespread implementation of mHealth technologies. OBJECTIVE This study aimed to assess whether an innovative mHealth technology system with several overlapping purposes can impact (1) clinical outcomes (ie, readmission rates, revisit rates, and length of stay) and (2) patient-centered care outcomes (ie, patient engagement, patient experience, and patient satisfaction). METHODS We compared all patients (2059 patients) of participating orthopedic surgeons using mHealth technology with all patients of nonparticipating orthopedic surgeons (2554 patients). The analyses included Wilcoxon rank-sum tests, Kruskal-Wallis tests for continuous variables, and chi-square tests for categorical variables. Logistic regression models were performed on categorical outcomes and a gamma-distributed model for continuous variables. All models were adjusted for patient demographics and comorbidities. RESULTS The inpatient readmission rates for the nonparticipating group when compared with the participating group were higher and demonstrated higher odds ratios (ORs) for 30-day inpatient readmissions (nonparticipating group 106/2636, 4.02% and participating group 54/2048, 2.64%; OR 1.48, 95% CI 1.03 to 2.13; P=.04), 60-day inpatient readmissions (nonparticipating group 194/2636, 7.36% and participating group 85/2048, 4.15%; OR 1.79, 95% CI 1.32 to 2.39; P<.001), and 90-day inpatient readmissions (nonparticipating group 261/2636, 9.90% and participating group 115/2048, 5.62%; OR 1.81, 95% CI 1.40 to 2.34; P<.001). The length of stay for the nonparticipating cohort was longer at 1.90 days, whereas the length of stay for the participating cohort was 1.50 days (mean 1.87, SD 2 vs mean 1.50, SD 1.37; P<.001). Patients treated by participating surgeons received and read text messages using mHealth 83% of the time and read emails 84% of the time. Patients responded to 60% of the text messages and 53% of the email surveys. Patients were least responsive to digital monitoring questions when the hospital asked them to do something, and they were most engaged with emails that did not require action, including informational content. A total of 96% (558/580) of patients indicated high satisfaction with using mHealth technology to support their care. Only 0.40% (75/2059) patients opted-out of the mHealth technology program after enrollment. CONCLUSIONS A novel, multicomponent, pathway-driven, patient-facing mHealth technology can positively impact patient outcomes and patient-reported experiences. These technologies can empower patients to play a more active and meaningful role in improving their outcomes. There is a deep need, however, for a better understanding of the interactions between patients, technology, and health care providers. Future research is needed to (1) help identify, address, and improve technology usability and effectiveness; (2) understand patient and provider attributes that support adoption, uptake, and sustainability; and (3) understand the factors that contribute to barriers of technology adoption and how best to overcome them.
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Affiliation(s)
- Courtenay R Bruce
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | - Patricia Harrison
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | - Tariq Nisar
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | | | - Neema M Tan
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | | | | | - Aroub Khleif
- Information Technology Department, Houston Methodist Hospital, Houston, TX, United States
| | - Nhan Tran
- Information Technology Department, Houston Methodist Hospital, Houston, TX, United States
| | - Sayali Kelkar
- System Quality & Patient Safety, Houston Methodist Hospital System, Houston, TX, United States
| | - Noreen Tobias
- Information Technology Portfolio Management Office, Houston, TX, United States
| | - Ana E Chavez
- Cardiovascular Surgery Associates, Houston Methodist Hospital, Houston, TX, United States
| | - Dana Rivera
- Houston Methodist Orthopedic and Sports Medicine - The Woodlands, Houston Methodist The Woodlands, The Woodlands, TX, United States
| | - Angela Leong
- Clinical Design and Planning, Houston Methodist Hospital System, Houston, TX, United States
| | - Angela Romano
- Houston Methodist Specialty Physician Group, Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, TX, United States
| | - S Nicholas Desai
- Department of Orthopedics, Houston Methodist Hospital, Houston, TX, United States
| | - Josh R Sol
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
| | - Kayla Gutierrez
- Houston Methodist Specialty Physician Group, Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, TX, United States
| | | | - Eric Haas
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Feibi Zheng
- Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Kwan J Park
- Department of Orthopedics, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen Jones
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States
| | - Paul Barach
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Roberta Schwartz
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
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